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On this day, February 24 1984, at St Vincent’s hospital in Sydney, a 39-year-old shearer from Armidale NSW was the recipient of the first successful heart transplant in Australia.
Performed by pioneering Australia surgeon Dr Victor Chang, the operation ushered in a new stage in organ transplantation in Australia. The shearer was the first Australian patient to live more than a few days after the surgery.
This new era was spearheaded by Dr Chang and his heart and lung transplant unit at St Vincent’s, who two months later performed Australia’s most famous and successful heart transplant. The then 14-year-old Fiona Coote, whose heart was weakened after complications of viral-induced tonsillitis, is still living a full life to this day.
Professor Karen Dwyer from Deakin University’s Faculty of Health argues that the first procedure was the catalyst Australia needed to become a global leader in transplantation, with the results of Coote’s operation bolstering the initial success. Prof Dwyer is a nephrologist, and the transplant specialist who led a team of surgeons in Australia’s only successful hand transplant, and she praises Dr Chang’s achievement. ‘This was an incredibly significant procedure; heart transplantation is lifesaving. Unlike with kidney failure, there is not an alternative life supporting therapy comparable to dialysis when the heart fails. It is finite. The procedure heralded a new era in transplantation in Australia,’ Prof Dwyer says.
So what has changed since then? According to Prof Dwyer the biggest issue facing those who need transplants is the same as it has always been: the lack of suitable donor organs. While 69% of Australians express an interest in donating their organs after brain death, only 1–2% of people die in specific circumstances where organ donation is possible. This shortage has led to some pioneering innovation by those carrying on Dr Chang’s legacy.
'The procedure heralded a new era in transplantation in Australia.'
Prof Karen Dwyer,
Faculty of Health, Deakin University
Professor Peter MacDonald now leads Dr Chang’s former unit, the heart and lung transplant unit at St Vincent’s Hospital in Sydney. Here he has adapted a procedure from kidney, lung and liver transplants that has revolutionised heart transplants and saved lives. ‘To increase the number of transplants, we are accepting donor organs that we may previously not have. We call this expanded criteria donors,’ Prof Dwyer explains. ‘One group of expanded criteria donors is donation after circulatory death. This is where the patient is not brain dead but there is no hope of organ recovery.’ According to Prof Dwyer, donation after circulatory death is where life support is withdrawn and if the patient’s circulation doesn’t cease within a defined period then the patient is ineligible to donate. ‘In this situation life support is withdrawn, and when the heart stops the organ is procured and transplanted,’ Prof Dwyer says.
So, if the heart has stopped how does that help the patient that needs a heart transplant? ‘What is remarkable is that the heart has stopped. They retrieve the heart, put it on a machine and using various parameters can see if the heart will recover,’ Prof Dwyer explains. By using this technique, and then injecting the heart with a unique preservation solution that limits the damage that the heart suffers while waiting to be utilised, the team at St Vincent’s have already saved four people. They further expect this to save an extra 30 people a year. ‘It’s remarkable. Ultimately they have been able to save lives that would either be still waiting for a deceased donor heart, or have died before receiving one,’ Prof Dywer says.
While these advancements are fantastic, Prof Dwyer claims that the best solution to a brighter future for organ transplantation is the simplest. ‘Improving organ donation is the key to improving patient outcomes. Currently the waiting list is long and many patients will become too sick or die before receiving a transplant,’ Prof Dwyer says. With more than 1400 Australians currently on the organ transplant waiting list, it’s simple really; ‘Timely transplants will improve patient outcomes,’ Prof Dwyer says.
Interested in changing the world through medicine or surgery? Check out Deakin University’s Bachelor of Medicine/Bachelor of Surgery.
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